How Can We Be More Honest in the Exam Room?

No matter how honest you are in everyday life, chances are you’ve told a lie in the exam room. Maybe self-medicating with CBD didn’t seem relevant to your visit, or you suspected you’d just get a lecture if you admitted that walking the dog is your main form of exercise. Or you reflexively shook your head no to a question about smoking because, c’mon, you’re not a full-fledged smoker. Regardless, you’re not alone.

In two recent surveys of more than 4,500 adults, researchers found that 60 to 80 percent of respondents have not been completely transparent with a clinician at some point. “It’s hard for any patient to admit things they might not be proud of,” says lead study author Angela Fagerlin, department chair of population health sciences at the University of Utah and a Veterans Affairs research scientist. “But if your goal is to be healthy, it’s usually best to admit what you’re hesitant to say.”

Patients omit information and twist details about their health habits for different reasons. Here are some of the more common reasons for those white lies — with expert insights to help you stay honest during your next appointment.

You don’t want to be judged

Among survey respondents, the most common reason for lying to a doctor was a fear of being judged or lectured. That’s precisely why Mike Robinson, 53, a blogger in Santa Barbara, California, says he failed to disclose his medicinal use of cannabis oils to a new oncologist.

Robinson was only seeing her for diagnostic work, as he’d decided to fight his cancer with cannabis and decline other treatment recommendations. Still, he suspected the oncologist would judge his nontraditional treatment plan and push him to try chemotherapy, so he filled out his patient intake form without mentioning his physician-prescribed THC oil.

Robinson’s seemingly minor omission had a snowball effect. One thing led to the next, and he wound up with a 30-day coverage suspension for treatment noncompliance. If he’d explained at the outset that he did have medicine, albeit not the traditional kind, Robinson says, he would have avoided the insurance drama: “Had I just filled out the intake form without that omission about what I was using for medicine, things would have gone smoothly. Very simply put, lying to your doctor only hurts you.”

“It’s human nature to try to look good; therefore, it’s very easy to withhold information that we [perceive] as negative,” says Dr. Setareh Alipourfetrati, a resident physician at Mount Sinai St. Luke’s hospital in New York City. “But your doctors are only as good as the information they have. By holding back details, you’re cheating yourself.”

With the rising use of shared electronic health records systems, seemingly minor lies can stick with you over time. “The data that you are not truthful about or hold back might be assumed as accurate by your future providers and in different settings,” Alipourfetrati says.

Think of your physician like a mailman, she suggests: “You don’t give the wrong address for your mail delivery just so that the mailman thinks you live in a better neighborhood. What you want is for your providers to deliver the best medical care tailored to your needs. To do that, they need to know you and your needs.” Medical professionals can help patients by creating a trusting and equal environment in the exam room. “I also always encourage and thank patients who [disclose] difficult-to-share information and tell them how helpful it is for me to know the truth,” she adds.

The idea that patients conceal unflattering details to skirt judgment is supported by psychological research. As social psychologist Lauren Howe explained in a piece for The Paper Gown, her work suggests that many patients view doctors as judgmental because they assume healthcare professionals are beacons of healthy living. But that’s not the case: On average, doctors are in pretty average health.

In the end, keep in mind that providers want to help. They’re asking questions to gather information, not to rate you. As Fagerlin puts it, “They see a whole spectrum of people and spend their time thinking about how to make you the healthiest you they can.”

You’re embarrassed

Our bodies do weird things. It can feel awkward or downright mortifying to tell a healthcare provider about incontinence or painful sex, or any number of health issues we’d rather keep between us and our browser histories. It’s probably not surprising that, according to the surveys, being embarrassed is the third most common reason for keeping doctors in the dark.

But even if you can’t bear to look your physician in the eye as you describe that disconcertingly fragrant rash, try to remember that doctors see patients with all sorts of conditions all day long. “There is nothing they haven’t seen, so it’s unlikely they would be fazed by your symptoms,” says Ryan Howes, a clinical psychologist in Pasadena, California. “They want to help, but if they can’t see [your issue] or don’t know about it, then they can’t help.”

If the prospect of openly discussing a problem makes you nervous, Howes suggests explaining that to your doctor: “‘Something like ‘I get so nervous at these appointments and have a hard time talking about my symptoms’ is likely to be met with words of understanding and reassurance from your doctor.”

If you really don’t want to talk about something during an appointment, tell your doctor you don’t want to answer that question today.

You could also write down your symptoms or concerns at home, bring the list with you and simply hand it to your doctor. “Yes, they will probably ask follow-up questions,” Howes says. “But once the main issues are out in the open and you see their concern and professionalism, it will be much easier to talk.”

And if you really don’t want to talk about something during an appointment, Alipourfetrati suggests being upfront. Tell your doctor “you don’t want to answer that question today,” she says. “This will prevent them from documenting inaccurate information or making incorrect decisions. It will also make them realize that this is a sensitive topic for you that they should address tactfully in the future.”

You don’t want to hear the truth

Beverly Friedmann, 30, a website content manager in New York City, told her doctor about most of her symptoms, including joint pain, fatigue, weakness and, despite daily workouts, minor weight gain. But she left occasional hair loss off the list, fearing that something serious was going on and hair loss would be the tip-off. “I worried it could be a sign of something related to fertility,” she says.

Friedmann’s doctor (accurately) diagnosed her with hypothyroidism. The condition was treated, but her symptoms didn’t fully abate. When she still didn’t feel 100 percent better a year later, she finally brought up the hair loss, prompting her doctor to run more tests and discover a vitamin B12 deficiency. “The delayed treatment resulted in other symptoms that were more severe in nature,” Friedmann says. “In retrospect, honesty would have saved a lot of time.”

Sure, it’s scary to find a lump or experience a new type of pain. Howes notes that acknowledging a frightening symptom or condition out loud can make it feel more real. “But you won’t get anything done by ignoring it,” he cautions. The sooner you have an accurate diagnosis, the sooner you can treat the issue.

You’re a people-pleaser

It’s not uncommon for patients to want their doctors to like them, says Fagerlin. “You think you will get better care if you say what you think they want to hear.”

But you’re not there to score points. For the sake of getting the most out of interactions with healthcare providers, try to resist the urge to pad the truth or automatically agree with everything your doctor recommends.

“We have this idea that in order to be the world’s best student or employee, that means top performance or straight A’s,” Howes says. “In the world of medicine and psychology, though, being a great patient means being completely authentic and disclosing everything.”

It’s understandable to regard physicians as authority figures. But you’re ultimately in charge of your health, so think of your doctor as your teammate instead. When you work together, you’re more likely to get the best-suited and most effective care.

Brittany Risher is a writer, editor and digital strategist specializing in health and lifestyle content. She's written for publications including Men's Health, Women's Health, Self and Yoga Journal.

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I’m just wondering if physicians lie when they see their doctors? I have doctors who have used the information I’ve shared with them against me. And now if I’m honest with them, I worry this new one will do the same. All doctors as all people are not alike so an article like this, I would think, should have a disclaimer. Physicians come into the exam room with ideas and thoughts of their own, ex. If I’m using marijuana but they don’t believe in it’s capabilities, they perhaps will either voice their opinions or inform you that using it could be detrimental to them. Medicine is a science not an exact like math. Things are proven right and good for us, only to later be bad for us. Vitamin C, the sunshine, alcohol to name a few. I think, we as individuals, should take it upon ourselves to keep informed and current with all of the latest news.

Read this next

For people with irritable bowel syndrome, it’s common to hear that symptoms such as cramping, alternating diarrhea and constipation, and bloating are “all in their head.” In the case of IBS, there’s actually some truth to this.

It’s not that their symptoms don’t exist. IBS is a very real disorder, and managing its physical toll often becomes an all-consuming effort. The litany of concerns that accompany so many activities — always scouting the closest bathroom, making sure you can reach it in time, farting in public — keeps many people with IBS from having a social life.

Yet according to some experts, IBS is not solely about what’s going on in the digestive system; rather, the brain exacerbates the condition. “IBS is a disorder of brain-gut dysregulation,” explains GI psychologist Sarah Kinsinger, who is also co-chair of the psychogastroenterology section of the Rome Foundation. Accordingly, addressing the “brain” side of IBS through cognitive behavioral therapy with a trained psychologist may help decrease both the anxiety that’s often associated with the disorder and its physical symptoms.

“CBT really should be the first-line treatment for people with IBS. It’s the treatment with by far the most empirical support, and when done well, it can be curative,” says Melissa Hunt, associate director of clinical training in the psychology department at the University of Pennsylvania.

In a series of trialspublished last year, researchers in the UK compared the standard treatment for IBS (typically diet and lifestyle modifications and/or medication) with eight sessions of CBT delivered over the phone or online. Before and after the trials, participants answered questionnaires designed to measure their anxiety, depression and ability to cope with their illness. Two years after the trials, 71 percent of the phone-CBT group and 63 percent of the online-CBT group reported clinically significant changes in their IBS symptoms. Meanwhile, less than half of the standard-treatment group reported such an improvement. Those who did CBT also exhibited lower levels of anxiety and depression and higher coping ability than other participants.

In an earlier meta-analysis (a study of studies), published in 2018 in the Journal of Gastrointestinal and Liver Diseases, a different team of researchers also found that CBT appeared to reduce both psychosocial distress and the severity of IBS symptoms, with a greater effect on the physical symptoms than on the mental ones.

Explainers

The brain-gut connection

How this happens is not completely clear at this point, but it’s believed to have something to do with how the gut and brain communicate.

“IBS is thought to be a disorder of centralized pain processing,” Hunt explains. “There is miscommunication between the pain centers in the brain and the nerves in the gut. In people with IBS, pain signaling gets inappropriately amplified.” Discomfort that wouldn’t even register in the majority of people feels like being stabbed in the gut to a person with IBS. “The best way to address that is to find ways to help reduce pain signaling, and that’s with a psychologist,” Hunt says.

CBT for IBS entails learning relaxation techniques, such as diaphragmatic breathing and progressive muscle relaxation, which help reduce the “volume” of the pain signals by activating the parasympathetic nervous system, i.e., the body’s “rest and digest” response. “This can also lead to increased blood flow and oxygen to the digestive system, which helps the GI tract to function in a more rhythmic way,” says Kinsinger, who is also an associate professor at Chicago’s Loyola University Medical Center.

CBT also involves thought restructuring. IBS can cause a cycle of worry: Worrying about symptoms leads to being hyperfocused on the slightest hint of any symptom, which increases anxiety, which aggravates symptoms. People with IBS also often catastrophize, meaning they assume the worst will happen (“If I have an accident at work, I’ll get fired and never get another job”), develop social anxiety and become withdrawn. CBT addresses these issues by shifting attention away from IBS symptoms and using exposure therapy to help people gradually engage in more activities outside their homes.

Additionally, using CBT, people with IBS learn to identify and change dysfunctional ways of thinking. For example, consider someone with school-aged children who asks their spouse to attend all school functions because they’re afraid of farting in a room with other parents, which would inevitably cause humiliation and might even make people think they’re disgusting A therapist might ask them how often they notice bodily noises from other people to help them realize that we’re a lot more cognizant of our own bodily functions than other people are. “In other words, we identify the catastrophic beliefs and then search for evidence supporting them or not,” Hunt says.

CBT is a skills-based, goal-oriented approach to treating mental disorders that emerged in the mid-20th century. All CBT programs share the same underlying goal of helping patients identify and modify negative or unhelpful thought patterns and behaviors. “It teaches patients techniques that they can then implement on their own.” says Kinsinger. “It can be done pretty efficiently, depending how motivated and receptive one is to learning these skills.” But over time, customized versions of CBT have been developed for specific conditions including insomnia, schizophrenia and IBS. Different versions of CBT use different techniques, such as role-playing, exposure therapy and relaxation exercises, and vary in length. On average, CBT for IBS lasts between 4 and 10 sessions in total.

Jeffrey Lackner, professor and chief of the division of behavioral medicine at the University at Buffalo, SUNY, says their program is structured like a course: “You learn a specific skill to manage your GI symptoms, process information differently or respond to stress in a less extreme way. Then you practice that skill in session before using it in the real world.” Often therapists also give patients homework to fine-tune the skills they learn. They come out of CBT with a toolbox of techniques to manage the day-to-day burden of IBS.

Some people with IBS do CBT on their own, using self-help books, online materials or apps without ever seeing a therapist. “Not many psychologists are trained to treat GI disorders specifically, so physicians don’t often have anyone to refer patients to,” Kinsinger says. The Rome Foundation trains psychologists and maintains a directory of gastrointestinal psychologists, but if someone can’t find a provider in their area, Hunt and Kinsinger recommend looking for a psychologist who’s trained in CBT and has experience treating chronic pain, panic disorders or anxiety.

Reducing sensations vs. reducing sensitivity

Not everyone is fully on board with CBT for IBS. One 2018 review study found “insufficient evidence to demonstrate the effectiveness of online CBT to manage mental and physical outcomes in gastrointestinal diseases” including IBS. A different 2018 review concluded that although psychological treatments for IBS appear to help in clinical trials, it’s unclear if they work in other settings and which treatments — such as CBT, mindfulness-based stress reduction and guided affective imagery — are most effective.

IBS is a complex problem, and some doctors prefer to integrate CBT with other treatments. But “by the time we see them,” Lackner says, “many of our patients have found that the medical treatments have not provided adequate symptom relief.”

Some IBS patients also find thetraditional approaches too hard to stick with. The most commonly prescribed treatment is a “low-FODMAP” diet, which requires giving up all dairy and legumes, plus many grains, fruits and vegetables. “Some trials show that even if the diet reduces or eliminates GI symptoms, it doesn’t improve quality of life because it’s crazy restrictive,” Lackner points out.

“With IBS, the nerve endings in the gut have become hypersensitized, and the brain magnifies those signals in the gut,” Hunt says. “The low-FODMAP diet tries to reduce the sensations, whereas CBT reduces the hypersensitivity. When you turn down the volume on the sensations, then you can eat whatever you want.”

Whether CBT helps with this brain-gut dysregulation, addresses distorted thinking and anxiety, or increases confidence in a person’s ability to manage gastrointestinal symptoms — or all of the above — it’s helped people with IBS resume parts of their life they’d put on hold.

Brittany Risher is a writer, editor and digital strategist specializing in health and lifestyle content. She's written for publications including Men's Health, Women's Health, Self and Yoga Journal.

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